Olive Oil_Fact Sheet 03

Scientific Basis for Olive Oil, Mediterranean Diet and Cancer Prevention
1. Introduction
Cancer accounts for about 20% of all deaths in Europe. However, cancer mortality
rates are generally highest in the northern and eastern European countries and lowest
in the Mediterranean countries. It is estimated that about 35% (range of 10-70%) of
all cancer deaths may be attributed to dietary factors.
Epidemiological studies provide most of the evidence on food and cancer. Good
dietary intervention studies of cancer risk however need to be large and very long
term, and so are rare.
2. Cancer and the Mediterranean diet
2.1 Role of body weight
Obesity is a clear risk factor for postmenopausal breast cancer and cancer of the
prostate, endometrium and gall-bladder. It is also probably a risk factor for renal-cell
carcinoma and cervical cancer. The public health message is "avoid obesity and
being overweight". This is reinforced by the link between obesity and diseases such
as heart disease, diabetes, gallstones, etc. As noted in previous Fact Sheets, the
Mediterranean diet is suitable for the prevention of obesity, and therefore for the
prevention of obesity-related cancer.
2.2 Role of dietary fat
Population studies show total fat intake is associated with cancer at a number of sites,
particularly the colon, breast, endometrium, ovary and prostate. All these cancers are
related to a Western-type diet and to excess energy intake. However, the public health
message is not clear, because prospective studies with breast cancer have failed to
show any relation to total fat intake, and one study on gastric cancer has suggested a
protective effect of fat intake derived from meat and dairy products, against gastric
cancers.
International correlation studies suggest that the type of dietary fat is important in the
aetiology of fat related cancers. Animal fat consumption per capita is positively
correlated with colon, prostate, breast and ovary cancer mortality rates. The case for
the relationship between animal fat intake and colorectal cancer risk is particularly
strong. In contrast, mortality rates of colon cancer are relatively low in Greece, Spain
and Southern Italy, where the intake of animal fat is low and olive oil is the most
common type of fat consumed.
Until recently vegetable fats/oils were considered to be neutral with respect to cancer
risk. However, recent analyses suggest that olive oil may have a protective effect
against cancer at certain sites, particularly breast cancer. PUFAs of the n-series in
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human studies show some protective properties against cancer whereas the n-series
appears to be neutral with respect to cancer risk. However, the role of n-6 PUFA
becomes less clear when also evaluating animal studies. Investigations have been
carried out on laboratory animals indicating that n-6 PUFA are more likely to
increase cancer risk than other types of fatty acids.
2.3 Role of protein
There is no evidence showing that there is an independent relationship between
protein consumption and cancer risk.
2.4 Role of complex carbohydrates and dietary fibre
It is not clear which component of the total complex carbohydrates provides the
protective effect which is seen. Cereals appear highly protective against cancers of
the colon, breast, endometrium and prostate. A prospective study has confirmed the
protective effect of high-fibre foods against colorectal cancer.
2.5 Role of fruit and vegetables
Epidemiological evidence shows that a high intake of fruit and vegetables,
particularly raw vegetables, protects against cancers at different sites, especially
those of the digestive and respiratory tracts and the hormone related cancers. They
have an anti-carcinogenic action at a wide range of sites and there is no positive
correlation between fruit and vegetable intake and cancer.
They contain a variety anti-carcinogenic agents: carotenoids, vitamin C and E,
dietary fibre, selenium, glucosinolate, indoles, flavenoids, protease inhibitors, and
plant sterols. Only the actions of anti-oxidant vitamins and provitamins have been
supported by human epidemiology, at present. However, it is likely that no single
agent functions as a key protective factor in isolation, but that all of them have some
protective role under some circumstances.
3. Role of olive oil in cancer
Various epidemiological studies indicate that the regular consumption of olive oil is
inversely associated with cancer at different sites. Most of the studies address the
relationship between olive oil and breast cancer or gastric cancer. While more
research work is needed, the existing evidence consistently, although not
conclusively, supports a protective role of olive oil in breast cancer prevention. A
protective effect of olive oil in gastric cancer is less clear. The only conclusion that
can be drawn at present for gastric cancer prevention is that increased fruit and
vegetable intake seems to be helpful.
Although there are also findings which suggest protective effects of olive oil for
cancer at other sites, e.g. colon, endometrium and ovary, the evidence is limited,
because the number of studies is small, and their results cannot be more than an
indication for a possible effect. However, no study would support a tumor-promoting
effect of olive oil.
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4. International recommendations for cancer prevention

There is general consensus that diet is an important component in the aetiology of
cancer. Scientific evidence is primarily derived from epidemiological studies as well
as from animal and in vitro experiments. In the former, foods or food groups are
more strongly associated with cancer risk than nutrients, and for many foods the
results are not persuasive or consistent. Well-designed, strictly controlled
intervention studies in humans which could support the role of single foods or
nutrients in cancer prevention with sufficient strength are missing. Thus, the
scientific evidence for detailed recommendations with respect to cancer prevention is
limited.
Several health authorities have made dietary recommendations for cancer prevention.
The recent guidelines of the American Cancer Society consist of 6 points:
Avoid obesity
Cut down on total fat intake
Include a variety of vegetables and fruits in the daily diet
Eat more high-fibre foods, such as whole grain cereals, vegetables and fruits.
Limit consumption of alcoholic beverages, if you drink at all
Limit consumption of smoked, salt-cured and nitrate-cured foods
Similar recommendations are given by the National Cancer Institute, but their
guidelines differ from those of the American Cancer Society by specifying levels of
nutrient intake for the general population (no more than 30% of total calories from
fat and 20-30 grams of dietary fibre daily).
The United States has started to implement these guidelines with a nation-wide
programme, called the "5-a-day for better health programme", disseminated via
supermarkets, restaurants, media, the public and research. The recommendations are
to consume mainly vegetable foods, to eat five or more portions of fruit and
vegetables per day, and, in addition, to eat six or more portions of bread, cereals or
grain per day.
"Europe against Cancer", the programme by the European Commission, has some
recommendations on nutrition and diet:
Increase the daily intake of fresh fruits and vegetables, as well of high fibre
grain products
Avoid obesity, increase regular physical activity, and limit the intake of highfat foods
Reduce alcohol consumption
The results of the November 1996 WHO conference "Nutrition in prevention and
therapy of cancer" will be published as consensus statements in the course of 1997.
As a general policy statement for reducing the risk of cancer it was said that fruits,
vegetables and whole-meal cereals should be the main components of the daily diet.
Avoidance of obesity and high alcohol intake as well as regular physical activity can
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contribute to a reduction of cancer risk. In addition, it was stated that there is no kind
of diet with which colon, gastric, breast or lung cancer could be treated.